Q: I have heard conflicting in formation on visit limitations on Medicare. Is it still 12 visits?
A: Medicare does not have a specified number of visits it will cover.
Any limits are based on the severity and acuity of the specific condition (diagnosis) of the patient. Though the primary diagnosis for a Medicare patient must be subluxation, bear in mind that the secondary musculoskeletal diagnosis is what sets the parameters of care. If your diagnosis is of a low level (pain or symptom only), it likely will result in allowance of a limited number of visits. Conversely, if you have a high-level diagnosis such as disc injury or sciatica, there is an increased number of visits typically allowed. Other tertiary factors such as complicating conditions - spondylosis, scoliosis, kyphosis, etc. - will indicate a greater need for care as well. To maximize a Medicare beneficiary's benefit, you must diagnosis their condition to the highest level of specificity. Medicare publishes a list of diagnoses that are acceptable as secondary diagnoses of chiropractic claims; these diagnoses also are categorized under short-, moderate- and long-term care. For a copy of these codes, please e-mail a request to
(noting that you read this article in DC), and I will forward a copy to you.
Samuel A. Collins
Santa Ana, California
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